1/6 Airways Disease, Obstructive Flashcards
6 Parts of Chapter 3. This is the first part
Define Asthma
Asthma is a chronic inflammatory condition of the airways, characterised by bronchoconstriction.
The most frequent symptons are: Cough - Wheezing - Chest tightness - Shortness of Breath. May require hospitalisation if it gets too bad
Outline the Aims of Treatment in Asthma
No daytime symptoms, no night time awakening due to asthma, no asthma attacks Peak Flow/ FEV1 Greater than 80% as in the normal lung.
Outline the lifestyle changes in Asthma
- Weight loss in Obese Patients
- Smoking Cessation
- Breathing Exercises
Exercise induced asthma indicates what?
Exercise induced asthma indicates poorly controlled asthma, may need stepping up
What is the process for stepping down in Asthma
To avoid unnessary costs, treatment is stepped down gradually every three months, Patients should be on the lowest dose of inhaled corticosteroid.
What is the Guideline for Asthma treatment for children ?
Start on SABA
Add Very Low Dose Corticosteroid.
IF under 5 we add LTRA
IF Over 5 we add LABA (but if LABA not effective, stop it)
What should Children Carry with them if they have high doses of Steroids and why?
Steroid Card should be issued for high doses, especially in kids as its associated with systemic ADRs such as Growth Failure, Reduced Mineral Bone Density, Adrenal Suppression
What is Moderate Asthma
In Moderate Asthma Patient:
- Can Talk
- Respiratory Rate Below 25
- Pulse below 110b/min
- O2 Saturation Above 92%
- Peakflow Greater than 75-50
In Severe Asthma What are symptoms
Severe Asthma can be any one of:
- Peak Flow 33-50%
- Repiratory rate ≥ 25/.minute
- Heart rate ≥ 110./minute
- Inability to complete sentences in one breath.
In Life threatening Asthma what are the features
Life threatening asthma can be any of the following:
- Peak Flow < 33%
- Arterial O2 Saturations below < 92%
- PaO2 < 8 kPa
- Normal Partial Arterial Pressure of CO2 (4.6-6.0 kPa)
- Silent Chest
- Cyanosis (Blue discouloration)
- Poor Respiratory Effort
- Arrhythmia
- Exhaustion
- Altered Consciousness
- Hypotension
If a person has Chronic Asthma, What is Step 1?
Step 1 is Mild Intermittent Asthma, We give: SABA , such as salbutamol or terbutaline, they’re also the safest SABAs for Asthma. Other SABAs such as ephinephrine hcl is less safe.
Whats step 2 and what determins if a patient switches from step 1 to step 2 in the chronic asthma management plan?
Are they using their inhaler more than once a week
Night time symptoms?
Have you had an exacerbation in the last two years?
Give ICS
What is the inhaled standard dose of a corticosteroid in adults and children over 12 years?
200-800 mcg/day on beclometasone disproionate or equivalent (fluticasone and Mometasone have the same clinical activitiy)
What is the inhaled standard dose of corticosteroid for a child between 5-12 years
The inhaled standard dose of corticosteroid for a child between 5-12 years is200-400 micrograms per day on beclometasone dispropionate or equivalent. (Fluticasone and Mometasone has the equivalent clinical activity as beclo)
Define Croup and How it’s treated
Croup is an inflammation of the larynx and trachea in children, associated with infection and causing breathing difficulties.
Mild Croup is self limiting, but treatment is with a single dose of corticosteroid e.g Dexamthasone is usually offered;
More Severe Croup (or mild croup that might cause complications) calls for hospital admission, nebulised Dexamthasone or budesonide will often reduce symptoms. Adrenaline is a last resort.
In the event of persistent poor control of Asthma, what doses are the max for:
- Children 5-12 years
- Adults and Children over 12
In persistent poor control, max dose ICS for children below 5 is 800 micrograms/day
for Children over 12 and adults, max dose is 2000 micrograms/day
Note: these are not standard doses.
In the final step of asthma control, what is given for persistent poor control of asthma?
Regular oral corticosteroid (prednisolone as a single daily dose).
Define COPD
Chronic Obstructive pulmonary disease, where there is airflow obstruction that is not fully reversible.
Reduced FEV1 / FVC ratio (<0.7).
Progressive and chronic condition
What tests do we run for diagnosis of COPD
- FEV1: The volume of air that the patient is able to exhale in the first second of forced expiration
- FCV: The total volume of air that the patient can forcibly exhale in one breath,
- The FEV1/FVC ratio determines diagnosis…
We also check:
- Smoking History
- Symptoms of breathlessness, persostent cough and sputum.
- Chest X Ray or chest CT scan.
- Arterial Blood gas test – oxygen level in blood.
Whats the distinguising features between COPD and Asthma?
In Athma
- Attack triggers - Common and Marked
- Freedom from symptoms? - Yes outside of the attacks
- First symtoms - Shortness of Breath and Wheeze.
In COPD
- Attack triggers - Less Marked
- Freedom from symptoms? - Unfortunately not
- First symptoms - Usually chromic cough and expectoration.
Give the NICE Algorithm for Treatment if your FEV1 is above 50%? and you have COPD
Initially either above 50% or below 50% FEV1 we give SABA or SAMA PRN.
Then, if FEV1 is above 50, and exacerbations or breathlessness is still persistent, give:
- LABA or LAMA and stop SAMA.
If still persistent, and on LABA give –> LABA + ICS in a combination inhaler.
if still persistent, but on LAMA instead, give LAMA + LABA + ICS.
The final stage for all is LAMA + LABA + ICS
in any case if ICS is declined or not tolerated, stop it and keep LAMA + LABA.
Give the algorith for treating a COPD patient if their FEV1 is below 50%?
Initially either above 50% or below 50% FEV1 we give SABA or SAMA PRN.
If FEV1 < 50%, we initiate straight to giving LABA+ICS combo inhaler or we can give LAMA on its own, stopping SAMA.
if its still persistent, we go to the final stage:
LAMA + LABA + ICS
in any case if ICS is declined or not tolerated, stop it and keep LAMA + LABA.
What are we most concerned about with Selective ß2 agonists?
Potentially serious hypokalemia may result from ß2 agonist theapy.. Caution and monitoring is required in severe asthma, as this risk is increased with concominant use with:
- Theophylline
- Corticosteroid
- Diruetics
Examples of Long acting ß2 agonists? and what inhalers are they found in?
Can they be given in the onset of an acute asthma attack?
- Formeterol
- Salmeterol
Formeterol is found in Symbicort, Fostair and Flutiform
Salmeterol is found in Seretide
Salmeterol is not given in the acute relief of an asthma attack, because its much slower than Salbutamol and Terbutaline. Formeterol can be given.
